J Baillargeon RJ Urban YF Kuo HM Holmes

. J Baillargeon, RJ Urban, YF Kuo, HM Holmes, MA Raji, A Morgentaler, BT Howrey, YL Lin, KJOttenbacher. Public Health Rep 2015;130:143–52
Testosterone therapy for late-onset hypogonadism is a controversial practice. What is not controversial is the need for appropriate patient selection and careful monitoring for treatment emergency adverse events in those patients who do choose to initiate SCR 7 therapy. While individual practitioners may vary in the details of their follow-up protocols, all experts agree that patients should be followed. This follow-up must include physical examination and routine laboratory testing.

Introduction
Squamous cell carcinoma of the penis (PC) is a rare cancer with an incidence of <1 in 100,000 men in North America and Europe [1]. Local control of invasive PC has traditionally been achieved with partial penectomy with a 2-cm margin, but recent literature shows more conservative resection margins have no effect on long-term oncologic control with the potential to further preserve acceptable sexual and urinary function [2-4]. While various studies have reported on functional outcomes after organ-preserving surgeries including glansectomy (removal of the glans) or distal corporectomy (removal of glans and <2-cm margin of distal corpora cavernosa), few have utilized a validated questionnaire to assess postoperative outcomes. Our objective was to investigate patient satisfaction with their sexual and urinary outcomes following organ-preserving surgery, including glansectomy or distal corporectomy, for carcinoma of the penis.
Patients

Methods
Approval was obtained by the Cleveland Clinic Institutional Review Board, and consent was obtained via telephone. Patients were asked to complete two questionnaires addressing their health and quality of life (QOL) and return the results by mail. The International Index of Erectile Function (IIEF-15) was utilized as a validated questionnaire to assess erectile function and satisfaction with sexual activity, and results were used to calculate a specific score for each patient regarding each of the four domains of sexual function represented on the IIEF [5].
The patient-reported outcome measure (PROM) for urethral stricture surgery, as reported by Jackson et al., was utilized as a validated questionnaire to quantify changes in voiding symptoms and health-related QOL following penile surgery [6]. The survey included 22 questions addressing urinary symptoms, sexual function, and perceptions of overall health and satisfaction with the operation.
Sociodemographic data and operation details were obtained through chart review and were codified and arranged in tables with questionnaire results. Patients were provided with a $25 Amazon.com gift card as compensation.

Results

Discussion
Penile cancer is most common in Asian, African, and South American countries where it accounts for up to 10% of cancers in men [1]. Poor hygiene is a risk factor most commonly associated with penile carcinoma, and high rates of early male circumcision likely explain low rates of PC in the United States. The infrequency with which PC is seen in Western, circumcised males has made it difficult to acquire data for studies addressing basic questions patients may have regarding postoperative sexual and urinary outcomes. Our study is the first to use standardized, validated questionnaires to evaluate sexual and urinary function in a U.S. patient population [7]. Patients were overall receptive to both the IIEF and PROM for urethral stricture questionnaires, with six patients matching study criteria consenting to the study and completing both questionnaires.
Maintenance of adequate sexual function is a very common concern for men undergoing treatment for penile cancer. It has been previously shown that seven of 25 men treated for penile cancer by various methods reported that, if asked again, they would choose a treatment with lower long-term survival to increase the chance of remaining sexually potent [8].